Large Pulmonary Artery Pseudoaneurysm Due to Lung Carcinoma

Abstract

We present the case of a 54-year-old patient who presented to our institution 4 months after refusing surgical treatment for a right upper lobe cavitary carcinoma. Weight loss, hemoptysis, and worsening pulsatile chest pain were the complaints. Radiologic restaging surprisingly revealed a large pulmonary artery pseudoaneurysm occupying the whole cavity area. A right pneumonectomy with intrapericardial pulmonary artery ligation was performed. Previous cases are extremely rare and differ from ours as patients presented with advanced lung cancer and thus, were not treated with resection, but with coil embolization.

Pulmonary Artery Pseudoaneurysm: A Rare Cause of Fatal Massive Hemoptysis

“…Other rare causes of PAPAs include chest wall trauma and iatrogenic trauma from PA catheters. Several case reports have described PAPAs resulting from lung cancer (including primary squamous cell cancer, primary sarcoma, and metastatic sarcoma) [ 4 , 6 – 8 ].…”

Pseudoaneurysm of pulmonary artery: rare complication of systemic chemotherapy

“…There are a handful of cases with invasive cancer presenting with pseudoaneurysm of pulmonary vasculature which resolve after the treatment of cancer with systemic chemotherapy 1 , 2 , 4 , 5 . Few case reports mention the occurrence of pseudoaneurysm of pulmonary vasculature after local invasive procedures like placement of Swan–Ganz catheter or after sessions of local chemotherapy 3 , 7 , 8 . Few cases mention adriamycin as the most commonly associated chemotherapy agent with pseudoaneurysm especially in patients undergoing transarterial chemoemobilzation (TACE) for hepatocellular carcinoma 6 – 8 , 10 .…”

Pulmonary artery pseudoaneurysm secondary to metastatic breast cancer

“…In previous literature, one case of epithelioid hemangioendothelioma, five cases of sarcoma relating to hemangiopericytoma, angiosarcoma and leiomyosarcoma, as well as 12 cases of primary lung cancer have been identified. [ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 ] Herein, we describe the first published case of a PAP originating from metastatic breast cancer.…”

“…[ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 ] Of all the cases of PAP arising from primary lung cancer, ten were squamous cell carcinomas, while small cell carcinoma and adenocarcinoma accounted for one case each, with all patients being males who presented with hemoptysis. [ 7 8 9 10 11 12 13 14 15 16 ] Squamous cell carcinoma of the lung is the most common neoplasm that causes PAP, due to its nature of causing necrosis, central cavitation, direct invasion, and erosion of the vessel wall. [ 9 11 ] Although PAP arising from primary lung malignancy has been previously described, its association with secondary metastasis, especially from primary breast cancer, is thought to be extremely rare.…”

“…[ 7 8 9 10 11 12 13 14 15 16 ] Squamous cell carcinoma of the lung is the most common neoplasm that causes PAP, due to its nature of causing necrosis, central cavitation, direct invasion, and erosion of the vessel wall. [ 9 11 ] Although PAP arising from primary lung malignancy has been previously described, its association with secondary metastasis, especially from primary breast cancer, is thought to be extremely rare. To the best of our knowledge, our case is the first reported.…”